Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach

Feiring, Eli; Lie, Astrid Eidesvik

doi:10.1186/s12913-018-3719-0

Cited by 23 publications

(23 citation statements)

References 30 publications

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“…Other researchers have examined the various context-specific facilitators and barriers to successful TS/S implementation [ 31 , 32 ]. This study builds on this research with a consensus from international TS/S scholars to advance a conceptual framework for TS/S programmes.…”

Section: Discussionmentioning

confidence: 99%

Conceptual framework for task shifting and task sharing: an international Delphi study

et al. 2021

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Background Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking. Methods We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. Results The panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists. The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight necessary conditions and important considerations for implementing TS/S programmes. Conclusion The COATS Framework offers a conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.

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Section: Discussionmentioning

confidence: 99%

Conceptual framework for task shifting and task sharing: an international Delphi study

et al. 2021

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“…Other researchers have examined the various context-speci c facilitators and barriers to successful TS/S implementation. 19,20 This study builds on this research with a consensus from international TS/S scholars to advance a conceptual framework for TS/S programmes. A central strength of our study is the use of a high quality international Delphi process, with reproducible panel selection processes, prespeci ed consensus criteria, and a prespeci ed number of Delphi rounds.…”

Section: Discussionmentioning

confidence: 99%

Conceptual Framework for Task Shifting and Task Sharing: An International Delphi Study

Orkin

Rao

Venugopal³

et al. 2020

Preprint

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BackgroundTask shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking.MethodsWe used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panellists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panellist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. ResultsThe panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists.The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general-purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight essential conditions and important considerations for launching TS/S interventions.ConclusionThe COATS Framework offers an essential theoretical and conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.

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“…In the face of impossible workloads, and the toll this takes on staff, the rational and economic case for task-sharing to lower skilled (and lower paid) workers such as HCAs seems clear, suggesting the process could be straightforward. Literature suggests the reality can be rather different 21 35–37. Any new cadre in the public sector would be introduced into settings beset by multiple challenges and with deeply embedded working practices, professional norms and jurisdictions.…”

Section: The Potential Space For Task Sharingmentioning

confidence: 99%

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

et al. 2020

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There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

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Factors perceived to influence implementation of task shifting in highly specialised healthcare: a theory-based qualitative approach

Cited by 23 publications

References 30 publications

Conceptual framework for task shifting and task sharing: an international Delphi study

Conceptual framework for task shifting and task sharing: an international Delphi study

Conceptual Framework for Task Shifting and Task Sharing: An International Delphi Study

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

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